Build a thriving personal injury practice with strong reports of findings and marketing plans
Patient diversity is the key to a self-sustaining practice. Some patients are able to pay with cash, while others rely strictly on insurance. Practice management should concentrate on creating, developing, and sustaining your practice with cost-effective, affordable, and responsible public relations and marketing programs. Build your personal injury (PI) practices with community awareness.
As biomechanical scientists with specific focus on the relationship between structure and function, it is imperative that we share our knowledge and concern, so that those with soft tissue trauma have access to a chiropractic evaluation.
There are some fundamental concepts and procedures that should be considered. Fear of testifying, and/or being embroiled in legal loops and hoops should not be a hinderance. Being called to court is rare and depositions are no more a fear factor than presenting a new patient spinal care class. If proper practice management skills and additional considerations are followed, the process will be simple.
Case history and report of findings. As mentioned above, one overwhelming concern for a number of doctors is the possibility of testifying in a deposition or court. The mere thought of this may frighten doctors from accepting PI patients or treating them too conservatively, thereby avoiding any need to support the care rendered. A careful case history review with an emphasis on the mechanics of the collision and the possible structural and paraspinal soft tissue insult takes a few extra minutes, but allows you to render a diagnosis, treatment plan, and, if necessary, testify at a later date.
A report of findings has multiple purposes with a PI case. Besides the normal report to your patient, it may be necessary to share the information with an insurance company or attorney. For those who struggle to compose coherent reports, commercial report writing software is available and can be helpful. I also recommend requesting one or two narratives from a colleague and change to outline your patient’s specific case. This is your opportunity to outline the facts as told to you, as well as your objective findings without embellishment or exaggeration. A well-written supplemental and narrative report illustrates to the insurance adjuster or attorney the rationale for care, as well as recommended protocol for subsequent rehabilitation and support. A well-documented report often prevents further legal discovery.
Verbal reports to patients should also emphasize the relationship between structure and function and how minor traumas upset the matrix of the human frame by producing immediate and often chronic residual effects. Use diagnostic tools that assist with illustrating soft tissue aberrations.
Gather knowledge. Prior to feeling comfortable discussing soft tissue injuries with patients, attorneys, or juries, it is helpful to increase your knowledge. There are many courses and books offered by chiropractors. Check with the American Chiropractic Association, International Chiropractic Association, and chiropractic schools continuing education programs for seminars that may also serve for license renewal hours. Seminars usually include an overview of the mechanics of a collision, examination procedures, diagnostic protocols, consultation, and report of findings, as well as logistics for record keeping and testifying. There are many professional seminars available, such as those conducted by Arthur Croft, DC, Dan Murphy, DC, and Pete Fernandez, DC.
License renewal and certificate impairment ratings classes will introduce you to the accepted guidelines used to rate personal impairment. Search for a ready resource about whiplash on the Internet. Use a search engine and type: “whiplash” or “soft tissue injury.”
Gather specific personal injury forms, including examination and report procedures. Forms include a case history review that asks specific questions pertinent to an auto collision. Your consultation should encompass a review of the incident, such as the precollision position of the patient; seated location; head position; dynamics of the vehicle versus vehicle impact; physical trauma; immediate subjective complaints; response to trauma such as a paramedic evaluation and trip to an emergency room or health care provider; procedures performed; subsequent complaints; physical, work, and social restrictions; and preexisting history of collisions and health conditions.
Once you record the patient history and note your examination findings, enter the data in your computer. A completed history is the essence of any deposition since it outlines the mechanics of the collision, physical response of the patient, subsequent complaints, loss or work restrictions, health care referrals, and rationale and protocol for treatment and rehabilitative programs. A written outline while it is fresh in your mind saves future stress to gather data and recreate the later.
Marketing a personal injury practice. To create awareness of your office and skills, contact the legal community. Attorneys have symbiotic relationships with doctors. They are unable to diagnosis and render treatment or a bill, so they need doctors to send clients—and it might as well be you. Their main concern is the ability of doctors to present a credible report and be willing witnesses if necessary. If you follow the guidelines above, this will become easy and second nature.
Start your marketing program by generating a database of local attorneys providing PI counsel. Check your Yellow PagesŪ and begin calling the firms that have advertised under the section “personal injury.” Call the firm and ask if they are accepting new clients. Tell them you are a chiropractor with a practice in the city and would like to add the attorney’s name to your referral list. Remember to get the proper spelling of the of the attorneys and paralegals who handle this area. Often, the paralegals are also seen by the new clients and may be the referral source for them. Send a welcome letter to the attorney and paralegals and be prepared to speak with them. A personal meeting at either their or your office will solidify this relationship, as well as offer time to discuss specific areas that they need handled, such as referrals, billing, and reports. Even if an attorney has a relationship with another chiropractor, they may have a client that lives or works closer to your office. I recommend that along with your business cards, you also offer a map of your office location.
If you feel comfortable with your knowledge, you may offer workshops for local attorneys or their staff. An outline with logistics to accomplish this can be found in Personal Injury Workbook.
Whether the PI business has been a flourishing and profitable portion of your practice or you are just getting started, it is imperative that you add to your base of knowledge, attend a few classes concerning this topic, and discuss the nuances with your colleagues. It is satisfying to assist those in need of immediate and supportive care.
Template of Supplemental Report On April 10, 2003, Mary Smith entered my office for evaluation of injuries reportedly sustained in a auto-related collision dated April 5, 2003. At the time of this evaluation, a general history and physical examination studies were performed. Following are the results of my findings: Description of accident: Smith, the driver of a Nissan Sentra, stopped for traffic when she was struck unawares from the rear by a Ford minivan, at approximately 25 mph. She relates that at the time of this collision, her foot was pressed on the brake pedal, while she was looking down at the floor toward the front passenger’s side and reaching with her right arm to retrieve an item. Her body and neck were thrust forward and backward with her right skull forcefully striking the headrest. The impact of her skull striking the headrest produced immediate pain and left her mildly “dazed.” Her mid-back also slammed hard onto the car seat. The mechanics of her reaching down and looking to the right just prior to impact, rotated her midthoracic spine, extended her right shoulder joint, and stretched a number of paraspinal soft tissue aligned to the corresponding ribs. The impact of her skull onto the headrest, along with the rotation of her head, produced chronic tension at the suboccipital region producing greater occipital neuralgia and torsion of the cervical spine and corresponding facets. As she left her vehicle, she felt disoriented and confused. After the police report, she drove home and rested. She placed ice on her skull and took Ibuprofen, then called her insurance carrier. She awoke the next morning with acute headaches. She states that the left side of her neck was very stiff, that she “couldn’t lift her head,” and sensed that her muscles were not working. She experienced a number of unusual sensations with moderate physical distortions, including her right shoulder remaining high upon action, a right hypersensitive elbow, and pain within the right pectoral region. During the days following her collision, when flexing her neck, she felt that she would “pass out” with nausea. Along with these subjective complaints, she has been experiencing lower back pain, spasms above her right knee and thigh, mild tinnitus in right ear, bilateral tingling within both hands, and tired eyes. She also and feels intermittently disoriented. Note: Due to the mechanics of the collision, her subjective complaints and my corroborating objective findings, I requested she refrain working from April 10–30, 2003. Treatment protocol: She was provided a number of supportive adjunctive orthopedic items that assist with the immediate pain, as well as reduce the instability and rehabilitate her soft tissue injuries. She was provided these durable items (CPT 90070): April 10, 2003—cervical pillow and lumbar support cushion. Due to the nature of her stiffness and spinal insult, conservative nonforce adjusting techniques are being used. Joint components of her right shoulder and cervical spine are extremely tight edging toward adverse adhesions. She was advised to perform a number of stretch exercises at home. An instructional video was provided. She was also instructed on specific therapeutic and rehabilitative band exercises to assist in stability with isotonic exercises in conjunction with adjustments during her office visits (CPT 97110). This is being used for the cervical, thoracic, shoulders, and lumbar areas. Her shoulder area was not responding with typical adjusting protocol and required a specific adjusting technique (CPT 98943-51) in conjunction with the various areas of her spine treatment (CPT 98941). Adjunctive therapy has been beneficial, including electrical muscle stimulation (CPT 97014) and moist heat to the area to assist with release of spasms (CPT 97010). Conservative use of spot x-rays were taken to rule out any contraindications for care and to focus on areas needing specific attention. Initial Suspected Diagnosis: A=acute / MO=moderate
• 847.0 (A-MO hyperflexion and extension cervical injury)
Resulting in:
• 723.1 (A-MO cervicalgia)
• 784.0 (greater occipital neuralgia–headaches)
• 847.1 (A-MO thoracic sprain/strain)
Resulting in:
• 724.1 (A-MO thoracic pain)
• 847.2 (A-MO lumbar sprain/strain)
Resulting in:
• 724.1 (A-MO lumbar pain)
• 729.1 (A-MO paraspinal myofascitis)
• 728.85 (A-MO paraspinal muscle spasms) Prognosis and Recommendations:
As of the date of this letter, Ms Smith has been cooperative and following her treatment schedule, as well as doing her homework of exercise and has adjusted her daily living habits, as recommended (CPT 97535). She is being actively treated by this office. I estimate a period of 6–8 weeks of conservative care. |
Joel E. Margolies, DC, has been in practice for 25 years in Atlanta and is the author of four books: Smart Start, Workshop Workbook, Chiropractic Marketing and Public Relations, and Personal Injury Workbook. He sends a free weekly chiropractic email newsletter concerning practice management, public relations, and philosophy to more than 10,000 DCs in 31 countries. Margolies can be reached via email: joel3639@aol.com, or website: www.chirosmart.net.
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